TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 361. GUARDIANSHIP SERVICES

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §§361.3, 361.25, 361.51, 361.53, 361.55, 361.57, 361.59, 361.61, 361.67, 361.69, 361.71, 361.73, 361.75, 361.79, 361.83, 361.151, 361.153, 361.155, 361.201, 361.203, 361.205, 361.207, and 361.209; new §§361.1, 361.21, and 361.23; and the repeal of §§361.1, 361.21, 361.23, and 361.81.

BACKGROUND AND PURPOSE

Effective March 15, 2022, the HHSC rules for guardianship services were administratively transferred from Texas Administrative Code (TAC), Title 40 Chapter 10, to TAC Title 26 Chapter 361. The rules were transferred from Title 40 to Title 26 due to the transfer of functions from the former Department of Aging and Disability Services to HHSC.

The purpose of this proposal is to update the guardianship requirements, practices, and procedures. The proposed amendments update the definitions used in the chapter and remove outdated terminology.

The proposal also updates agency names by replacing "DADS" with "HHSC."

SECTION-BY-SECTION SUMMARY

SUBCHAPTER A GENERAL PROVISIONS

The proposed repeal of §361.1, Introduction, is needed because the content of the rule contains information covered in proposed new §361.1, Purpose, §361.21, Eligibility for Services, and §361.23, Assessment.

Proposed new §361.1, Purpose, incorporates the content of §361.1, Introduction, which is proposed for repeal, to provide an overview of the HHSC Guardianship Services Program's purpose.

The proposed amendment to §361.3, Definitions, removes the definition of "Agency" that is currently used in the rules and replaces it with the definition of "Guardianship program." This change is made to use the term guardianship program in the rules to refer to other guardianship programs. The proposed amendment removes terms that contain "DADS" and the term "Diminished capacity" because they are not used in the chapter. The proposed amendment makes changes to add the acronym for a term at the beginning of the definition. This allows the acronyms to be used in the rules without first spelling them out. The proposed amendment adds definitions of "Alternatives to guardianship," "Guardian," "Incapacitated person," and "Supports and services," which are defined in the Texas Estates Code and used in the chapter. The term "Guardianship Services Program" is added to define the HHSC program referenced in this chapter. "HHSC" is added to define the agency in these rules. The term "Individual" is added to describe the people who receive services from the HHSC Guardianship Services Program (GSP) and from contractors. The proposed amendment revises the definitions of "Assessment," "CME--Certificate of Medical Examination," "Contractor," "DID-- Determination of intellectual disability," "Judicial Branch Certification Commission," "Person-directed planning," "Quality assurance plan," and "Service plan" to update terminology and make them easier to read and understand.

SUBCHAPTER B ELIGIBILITY AND ASSESSMENT OF INDIVIDUALS FOR GUARDIANSHIP SERVICES

The proposed repeal of §361.21, Eligibility for Services, is needed because the content of the rule contains information covered in proposed new §361.21, Eligibility for Services.

Proposed new §361.21, Eligibility for Services, provides clear information about the eligibility requirements for the GSP to match current statutes and memorandums of understanding with the Department of Family and Protective Services (DFPS). To match the Child Protective Services (CPS) Memorandum of Understanding the proposed new rule includes that an individual must be referred by a CPS employee; a person with an intellectual disability or alleged to be a person with an intellectual disability, must be a person with a Determination of Intellectual Disability as defined in 26 TAC §304.102, and a person who meets the requirements of Texas Estates Code §1101.104. The proposed new rule includes details about referrals when a person is at least 17 years of age or 18 years of age. The proposed new rule describes the requirement in Texas Estates Code §1103.003 that the guardianship of an individual meeting the criteria in proposed new subsection (a) may not take effect before the date of the individual's 18th birthday. This allows the HHSC GSP to file an application no earlier than 180 days before the individual's 18th birthday in accordance with Texas Estates Code 1103.001, Application for Appointment. Receiving referrals at 17 years or older allows for adequate time to process the referral, conduct the assessment, and file an application for guardianship. The proposed new rule identifies the eligibility criteria for an individual referred to the GSP by the Adult Protective Services Division (APS) of DFPS. The proposed new rule indicates the person must be aged 65 years or older or 18 years of age or older and is a person with a disability; APS has reason to believe the individual is an incapacitated person; and APS has validated that the individual is in a state of abuse, neglect, or exploitation; and the GSP determines guardianship is appropriate. The proposed new rule includes requirements related to citizenship or legal residency in the United States to match program eligibility requirements. The proposed new rule lists additional factors considered by HHSC to decide whether to serve as permanent guardian. The proposed new rule updates language from the proposed repeal of §361.21, Eligibility for Services, to make the rule easier to read and understand.

The proposed repeal of §361.23, Assessment, is needed because the content of the rule is covered in proposed new §361.23, Assessment.

Proposed new §361.23, Assessment, describes the assessment process when the GSP receives a referral from DFPS under §361.21 or a court request under Texas Estates Code §1203.108 or Human Resources Code §161.101(d). The proposed new rule describes how the GSP processes a referral for guardianship including reviewing documentation; conducting an in-person assessment to evaluate an individual's alleged incapacity; considering alternatives to guardianship; evaluating the availability of alternate guardians; and determining whether to accept or deny a referral.

The proposed amendment to §361.25, Annual Review of a Ward's Status, changes the title of the rule to "Annual Status Review of an Individual." The proposed amendment changes all references to a "ward" to references to an "individual." The proposed amendment simplifies and condenses the language that describes what actions the GSP takes when an individual's status changes. The proposed amendment combines subsections related to alternative guardians; changes language related to modifying a guardianship to match the Texas Estates Code; adds new language to address restoring an individual's capacity; and updates language to address when a guardianship does not effectively remedy the issues or meet the needs of the individual.

SUBCHAPTER C CONTRACTOR REQUIREMENTS

The proposed amendment to §361.51, Guardianship Contracts, removes mentions of DADS and makes changes to use plain language.

The proposed amendment to §361.53, Eligibility To Be a Contractor, changes the requirements for a contractor to be eligible to apply for a guardianship contractor to match statutory requirements for guardianship programs, including requirements from the Judicial Branch Certification Commission for guardianship programs and the certification of guardians. The proposed amendment then removes the requirements in subsections (b) and (c) because they are included with the changes in subsection (a). The proposed amendment adds the requirement for a contractor's application with HHSC to identify the geographical areas served and the population groups for whom the contractor provides services. The proposed amendment reformats and clarifies the requirement describing when a contractor must terminate an employee and the description of the actions of a contractor that the GSP may use to decide current or future eligibility to contract with HHSC.

The proposed amendment to §361.55, Acceptance of Referrals from DADS, changes the title to "Acceptance of Referrals from HHSC" and removes references to DADS. The proposed amendment removes a contractor application requirement because this requirement is being added in the proposed amendment to §361.53. The proposed amendment renumbers the remaining subsections and edits the remaining rules to improve clarity and readability.

The proposed amendment to §361.57, Policies and Procedures Required of Contractors, adds details about what circumstances lead to a contractor no longer serving as guardian and require notice to the HHSC GSP. The proposed amendment makes changes to use plain language.

The proposed amendment to §361.59, Qualifications and Training Requirements for Contractor Employees, removes the current requirement to provide an adequate number of qualified employees, and the list of qualifications for contractor employees, and replaces them with the requirement for the contractor to follow the Judicial Branch Certification Commission standards regarding maximum caseloads and the requirement to employ case managers certified as guardians by the Judicial Branch Certification Commission. These changes are made because the Judicial Branch Certification Commission is the entity responsible for standards regarding maximum caseloads and guardian certification requirements. The proposed amendment updates and clarifies the employee training requirements for contactors, including removing certain trainings and replacing them with training that explains an overview of the Judicial Branch Certification Commission Code of Ethics and Minimum Standards for Guardianship. This change is made because the Judicial Branch Certification Commission provides standards to make decisions and requirements for certified guardians. The proposed amendment requires a contractor to maintain a personnel record on every employee.

The proposed amendment to §361.61, Qualifications and Training Requirements for Volunteers of Contractors, removes references to DADS and reorganizes rule language to make the rules easier to read and understand. The proposed amendment requires a contractor to maintain a personnel record on every volunteer.

The proposed amendment to §361.67, Criminal Background Checks, changes the title of the rule to "Background Checks" to match the language required by the Department of Public Safety when conducting a background check. The amendment also updates statute references to match current statute titles.

The proposed amendment to §361.69, Quality Assurance Plan, removes the word "ward" and reorganizes rule language to make the rules easier to read and understand.

The proposed amendment to §361.71, Fiscal Management, removes references to DADS, updates to use person-first language, and makes minor wording changes to improve clarity and readability.

The proposed amendment to §361.73, Roles and Responsibilities of Case Managers, changes the title to "Roles and Responsibilities of a Contractor Providing Guardianship Services." The proposed amendment removes requirements that are required for all guardianship programs or all guardians. The proposed amendment also expands language to be specific in the rule about the roles and responsibilities of a contractor. For example, the proposed amendment lists reasons for case closure and removes requirements related to guardian of the estate.

The proposed amendment to §361.75, Reporting of Abuse, Neglect, or Exploitation, indicates abuse, neglect, or exploitation of an individual is reported to the appropriate investigating authority. The proposed amendment, because reporting is not limited to DFPS, removes subsection (b) and the rest of the rule is reformatted. The proposed amendment reorganizes rule language to make the rules easier to read and understand.

The proposed amendment to §361.79, Responsibilities of the Guardian of the Person, requires a contractor, when appointed guardian of the person, to manage the individual's case according to the court order appointing the contractor as guardian and the requirements in the Texas Estates Code for Guardian of the Person. The proposed amendment adds a contractor's responsibility to manage the individual's finances to clearly explain what is expected of the contractor. The proposed amendment uses person-first language and makes changes for clarity and readability.

The proposed repeal of §361.81, Responsibilities of Guardian of the Estate, removes an outdated rule because the GSP does not refer an individual to a contractor for appointment as the guardian of the individual's estate.

The proposed amendment to §361.83, Service Plans for Wards, changes the rule title to "Service Plan for Individuals." The proposed amendment removes some specific services plan requirements and replaces them with references to the Judicial Branch Certification Commission Minimum Standards for Guardianship.

SUBCHAPTER D RECORDS MANAGEMENT being retitled as CASE RECORDS MANAGEMENT

The proposed amendment to §361.151, Confidentiality of Records, makes minor rule edits for clarity and use of person-first language. The proposed amendment removes confidentiality standards for DADS employees because this rule is for contractors. The proposed amendment removes references to releasing records to an attorney ad litem because an attorney ad litem is not involved when a contractor becomes the successor guardian to HHSC. The proposed amendment removes language about a contractor releasing information to a social services or medical agency without permission from the current guardian. This change is made because a contractor does not manage cases unless the contractor is appointed as guardian.

The proposed amendment to §361.153, Documentation Requirements, changes the title of the rule to "Case Records of an Individual." The proposed amendment removes the rules for a contractor to maintain financial and contractor-related records because these rules have been moved to proposed §361.155. The proposed amendment adds requirements for searching and documenting the results from the National Sex Offenders Registry website for unsupervised visits because these rules have been removed from proposed §361.67. The proposed amendment removes the requirement for a contractor to maintain personnel records for employees and volunteers because these rules have been moved to §361.59 for employees and §361.61 for volunteers. These changes are being made to improve the organization of these rules within the chapter. The proposed amendment includes the requirements for a contractor to make case records available to the GSP during monitoring visits, for the contents of a case record, and for documenting contacts with an individual.

The proposed amendment to §361.155, Maintenance of Records, adds the requirements removed from §361.153 about maintaining financial and contract-related records and then reformats the rest of the rule. The proposed amendment removes references to DADS and updates and clarifies the requirement if there is a change in the location of the records or the contact to access the records.

SUBCHAPTER E CONTRACTOR MONITORING AND COMPLIANCE

The proposed amendment to §361.201, Monitoring Reviews, removes references to DADS and "ward" and makes minor edits to improve clarity.

The proposed amendment to §361.203, Complaint Investigations, removes references to DADS and "ward" and makes minor edits to improve clarity.

The proposed amendment to §361.205, Fiscal Monitoring, removes references to DADS and "ward" and makes minor edits to improve clarity.

The proposed amendment to §361.207, Sanctions, removes references to DADS and "ward" and makes minor edits to improve clarity. The proposed amendment updates the TAC reference for a contractor's right to appeal.

The proposed amendment to §361.209, Administrative Review, removes references to DADS and "ward" and makes minor edits to improve clarity. The proposed amendment clarifies that a contractor's request for an administrative review must be received by the GSP within 10 calendar days after the date the contractor receives the written review findings.

FISCAL NOTE

Victoria Grady, Deputy Chief, Finance, has determined that for each year of the first five years that the rules will be in effect, enforcing or administering the rules does not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rules will be in effect:

(1) the proposed rules will not create or eliminate a government program;

(2) implementation of the proposed rules will not affect the number of HHSC employee positions;

(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;

(4) the proposed rules will not affect fees paid to HHSC;

(5) the proposed rules will create new regulations;

(6) the proposed rules will expand, limit, and repeal existing regulations;

(7) the proposed rules will not change the number of individuals subject to the rules; and

(8) the proposed rules will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Victoria Grady has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because the rules conform to current procedures and there are no requirements to alter business practices.

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these rules because the rules do not impose a cost on regulated persons.

PUBLIC BENEFIT AND COSTS

Rosa Berumen, Director, Office of Guardianship Services has determined that for each year of the first five years the rules are in effect, the public benefit will be accurate and clear rules about guardianship services at HHSC and the requirements to contract with HHSC to provide guardianship services. Revisions reflect current rules, regulations, and statutes related to guardianship services.

Victoria Grady has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because the rules conform to current procedures and there are no requirements to alter current business practices.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that the proposal does not restrict or limit an owner's right to the owner's property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal, including information related to the cost, benefit, or effect of the proposed rule, as well as any applicable data, research, or analysis, may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 26R041" in the subject line.

SUBCHAPTER A. GENERAL PROVISIONS

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Human Resources Code §161.073, which provides that the executive commissioner of HHSC may adopt rules for the administration of guardianship services.

The repeal affects Texas Government Code §524.0151 and Texas Human Resources Code §161.073.

§361.1. Introduction.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 9, 2026.

TRD-202603924

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 25, 2026

For further information, please call: (210) 267-7419

STATUTORY AUTHORITY

The amendment and new section are authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Human Resources Code §161.073, which provides that the executive commissioner of HHSC may adopt rules for the administration of guardianship services.

The amendment and new section affect Texas Government Code §524.0151 and Texas Human Resources Code §161.073.

§361.3. Definitions.

[(b)] [In addition, the following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:]

(2) Assessment--The process to determine whether [of establishing whether DADS] guardianship is appropriate for an individual referred to the GSP [by DFPS]. [The assessment includes a determination of whether the individual appears to meet the definition of an incapacitated person as defined by Texas Estates Code, §1002.017(2), and if the definition is met, whether the individual is totally without capacity or lacks capacity to do some, but not all, the tasks necessary to care for himself or herself or to manage his or her property, whether there is a less restrictive alternative to guardianship, and whether the individual meets the eligibility criteria for the DADS Guardianship Services Program.]

(3) CME--Certificate of Medical Examination. [(CME)--] A written statement from [by] a qualified health care provider that states [physician attesting to] whether, in the [physician's] medical opinion of the provider, an individual has capacity. The statement must meet the requirements of [that complies with] Texas Estates Code[,] §1101.103.

(4) Contractor--A guardianship program that has a contract with HHSC [An agency with which DADS has a contract] to provide guardianship services for a fee.

(5) [(7)] DID--Determination of intellectual disability. [(DID)--] An examination, or an update or endorsement of a prior examination, that meets the requirements of [complies with] Chapter 304 [5], Subchapter D of this title (relating to Determination of Intellectual Disability [Diagnostic Eligibility for Services and Supports--Intellectual Disability Priority Population and Related Conditions)] and with Texas Estates Code[,] §1101.104.

(6) [(8)] DFPS--The Department of Family and Protective Services.

(13) [(10)] Judicial Branch Certification Commission--The commission established under Texas Government Code §152.051[, Chapter 152].

(14) [(11)] Person-directed planning--An ongoing [A] process that empowers an individual and the legally authorized representative (LAR) on the individual's behalf to direct the development of a [service] plan to meet the needs of the individual [for a ward that meets the individual's personal outcomes. The service plan must identify existing supports and services necessary to achieve the individual's outcomes, identify natural supports available to the individual and negotiate needed service system supports, occur with the support of a group of people chosen by the individual and the guardian as LAR on the individual's behalf, and accommodate the individual's style of interaction and preferences regarding time and setting].

(15) [(12)] Quality assurance plan--A written plan:

(A) that describes:

(i) a contractor's system of self-monitoring; and

(ii) how the contractor ensures [to ensure] consistency and quality of care for an individual; and

(B) ensures the contractor's [provided to a ward and ensure] compliance with:

(i) the Texas Estates Code;[, other]

(ii) requirements imposed by the courts;[, and]

(iv) the contractor's own [other] program policies and procedures[, rules, and standards].

(16) [(13)] Reporter--A person who makes a report [referral] to DFPS that alleged or suspected [staff about a situation of alleged] abuse, neglect, or exploitation, as defined in 40 TAC §§705.103, 705.105, and 705.107, respectively, has occurred or may occur of an elderly person or adult person with a disability as defined in Texas Human Resource Code §48.002.

(17) [(14)] Service plan--A plan outlining an individual's goals, needs, and preferences. [of care for a ward that ensures appropriate habilitation and rehabilitation services, including therapy, counseling, education, and training to the extent permitted by the ward's estate.]

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 9, 2026.

TRD-202603925

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 25, 2026

For further information, please call: (210) 267-7419

SUBCHAPTER B. ELIGIBILITY AND ASSESSMENT OF INDIVIDUALS FOR GUARDIANSHIP SERVICES

STATUTORY AUTHORITY

The repeals are authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Human Resources Code §161.073, which provides that the executive commissioner of HHSC may adopt rules for the administration of guardianship services.

The repeals affect Texas Government Code §524.0151 and Texas Human Resources Code §161.073.

§361.21. Eligibility for Services.

§361.23. Assessment.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 9, 2026.

TRD-202603926

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 25, 2026

For further information, please call: (210) 267-7419

STATUTORY AUTHORITY

The amendment and new sections are authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Human Resources Code §161.073, which provides that the executive commissioner of HHSC may adopt rules for the administration of guardianship services.

The amendment and new sections affect Texas Government Code §524.0151 and Texas Human Resources Code §161.073.

§361.25. Annual Status Review of an Individual [a Ward's Status].

(a) At least annually after HHSC's qualification [the DADS Guardianship Services Program's appointment] as guardian for an individual, the GSP [a ward, the DADS Guardianship Services Program] evaluates the individual's status [of the ward] to determine if:

(1) the individual still meets the definition of [ward is still] an incapacitated person and continues to need a guardian;

(2) an alternate guardian [person or guardianship program] is willing, able, and suitable to serve as successor guardian;

(3) alternatives [a less restrictive alternative] to guardianship are [is now] available [and the ward can be restored to capacity];

(4) a modification of the guardianship or restoration of capacity is appropriate [limited guardianship is appropriate and the ward can be partially restored to capacity]; [or]

(6) [(5)] guardianship continues to effectively remedy the issues and meets [of the ward or meet] the needs of the individual [ward].

(b) If the GSP becomes aware of an appropriate [the DADS Guardianship Services Program determines that the ward is still an incapacitated person and an] alternate guardian, the GSP [can be identified, the DADS Guardianship Services Program] notifies the [appropriate] court [with probate jurisdiction] and may file [files] an application for HHSC to resign as guardian pending appointment of [and have] a successor guardian [appointed].

(c) The GSP files an application with the court to modify rights when the GSP determines the powers and duties of the guardian no longer meet the needs of the individual. [If the DADS Guardianship Services Program determines that the ward is no longer an incapacitated person and no longer needs a guardian, the DADS Guardianship Services Program files an application with the court to have the ward restored to capacity. If a less restrictive alternative is appropriate and available, the DADS Guardianship Services Program refers the restored individual for the appropriate services.]

(e) The GSP files an application with the court for HHSC to resign and terminate the guardianship if the GSP determines the guardianship does not effectively remedy the issues or meet the needs of the individual. [If the DADS Guardianship Services Program determines guardianship does not effectively remedy the issues of the ward or meet the needs of the ward, the DADS Guardianship Services Program files an application to resign or close the guardianship.]

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 9, 2026.

TRD-202603927

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 25, 2026

For further information, please call: (210) 267-7419

SUBCHAPTER C. CONTRACTOR REQUIREMENTS

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Human Resources Code §161.073, which provides that the executive commissioner of HHSC may adopt rules for the administration of guardianship services.

The amendments affect Texas Government Code §524.0151 and Texas Human Resources Code §161.073.

§ 361.51. Guardianship Contracts.

(a) Texas Human Resources Code[,] §161.103 gives HHSC [DADS] the authority to contract with a guardianship program [an agency] or a political subdivision of the state for the provision of guardianship services.

(b) To the extent the legislature appropriates funds or HHSC makes funds available, HHSC [are appropriated by the legislature or made available by DADS, the DADS Guardianship Services Program] contracts with one or more contractors to file an application [with the probate courts and] to serve as successor guardian [of the person or guardian of the estate or both]. A [The] contractor must be able and willing to serve as guardian at a cost equal to or less than the cost of providing comparable guardianship services by the GSP [DADS Guardianship Services Program].

(c) To be eligible for guardianship services through a contractor, an individual must meet the eligibility requirements in §361.21 of this chapter (relating to Eligibility for Services). [be eligible to be a ward of the DADS Guardianship Services Program.]

(d) Funding from the [DADS] guardianship contract [contracts] is intended to offset the contractor's cost of providing guardianship services. A contractor must not:

(1) use contract [DADS] funds to pay for an individual's [a ward's] daily living expenses; or

(2) bill an individual [a ward] for any [other] services.

(e) A contractor must comply with the requirements in [this subchapter and in] Subchapters C - E [D - E] of this chapter (relating to Contractor Requirements, Case Records Management, and Contract Monitoring and Compliance). If a contract with HHSC [the DADS Guardianship Services Program] is terminated or is not renewed, a contractor may continue providing services using another [through an alternate] source of funds or file an application with the court [apply to the courts] to resign as guardian and request the appointment of [have] a successor guardian [appointed].

§361.53. Eligibility To Be a Contractor.

(a) To be eligible to apply for a guardianship contract, a contractor [with DADS, an agency] must: [meet the definition of a guardianship program in Texas Estates Code, §1002.016.]

(c) [(d)] A contractor must [An agency must agree to] terminate an employee whose actions result in the contractor [who commits an action that results in the agency] being removed as guardian by a court. Failure [the courts. If the agency fails] to take action against such an employee or [has demonstrated] a pattern of removals [activity resulting in removal] as guardian by the courts within the previous five years, may result in the contractor becoming [the agency may become] ineligible to contract with HHSC [the DADS Guardianship Services Program].

(d) [(e)] If a contractor [an agency] is held in contempt, fined, surcharged, removed as guardian, or found not suitable to serve as guardian by the courts, the GSP may use these actions to decide current or [the DADS Guardianship Services Program may consider these actions in determining present and] future eligibility and the contractor [agency] may become ineligible to contract with HHSC [the DADS Guardianship Services Program].

§361.55. Acceptance of Referrals from HHSC [DADS].

(a) [(b)] A contractor must accept all referrals from the GSP [DADS] and apply for [guardianship or] successor guardianship when an individual meets the contractor's eligibility criteria. A contractor must not accept referrals if the total number of individuals served exceeds [if a contractor serves the county in which the incapacitated individual resides, and if the individual qualifies for the contractor's guardianship program, provided that the contractor is under] the maximum service authorization level provided in the contract. If the contractor reaches [has reached] the maximum service authorization level, the GSP [provided in the contract, DADS] may offer the contractor an opportunity to apply for successor guardianship and provide services using another funding source [through other sources of funds].

(b) [(c)] If a contractor believes that the GSP [DADS] has assigned an individual for [guardianship or] successor guardianship who does not meet [fit] the contractor's [guardianship program's] eligibility criteria, the contractor may request that the GSP reconsider the referral. At the GSP management's discretion, the GSP may withdraw the referral. [the DADS Guardianship Services Program management and the appropriate guardianship supervisor to reconsider the referral. The DADS Guardianship Services Program management or the appropriate guardianship supervisor may, at the management's or supervisor's discretion, withdraw the referral to the contractor.]

§361.57. Policies and Procedures Required of Contractors.

A contractor must have written policies and procedures that:

(1) identify the contractor's management structure, including [of the agency and clearly reveal] the decision-making authority and chain of command;

(2) specify the [establish] qualifications for employees and volunteers, including [that indicate] type of position, required education [required], and any licensure requirements;

(3) describe hiring practices and ensure compliance with applicable state and federal laws;

(4) describe the training [what orientation will be] provided to employees and volunteers, including the [what] additional training required for [will be provided if] volunteers [are used];

(5) ensure that all allegations of abuse, neglect, or [and] exploitation are reported to the appropriate investigating agency [DFPS as mandated by state law];

(6) describe actions [to be] taken if an individual under guardianship experiences [a ward has] a crisis and requires [needs] emergency services [help];

(7) adhere to the Code of Ethics and Minimum Standards for Guardianship Services [describe the minimum standards for guardianship] adopted by [rule by] the Judicial Branch Certification Commission [Office of Court Administration] when serving as a guardian; and

(8) [(9)] include procedures for:

(A) complying [compliance] with court orders and other local practices based on [upon] the court system in the geographic area;

(B) [(10) include a system for] receiving complaints, recording the complaints, and documenting actions taken; [taking action; and]

§361.59. Qualifications and Training Requirements for Contractor Employees.

(a) A contractor must:

(2) employ case managers certified as guardians by the Judicial Branch Certification Commission; [who have the following qualifications:]

(3) provide training during orientation to an employee providing guardianship services or having direct contact with individuals [an orientation program] that covers [explains]:

(A) the responsibilities associated with the [each new] employee's position;

(B) the responsibilities of the contractor [guardianship program] to the individual [ward];

(C) the relationship of the individual [ward] to the contractor [guardianship program] and to HHSC [DADS];

(D) an overview of the Texas Estates Code and the contractor's [program's] responsibilities as guardian of the person under [per] the code;

(E) an overview of [any] rules or regulations that affect the contractor [guardianship program];

(F) an overview of the Judicial Branch Certification Commission Code of Ethics and Minimum Standards for Guardianship [aging and disability; medical issues, including medical treatment and medication; and end-of-life decisions];

(G) the principles of person-directed planning including consideration of an individual's [a ward's] personal preferences, desires, religious beliefs, and living arrangements; and

(H) the principles of informed consent, [principle of] substituted judgment, and the best interest standard for decision-making; and

(4) maintain a copy of the continuing education training required in subsection (b) of this section provided to [information presented at the orientation for] each certified guardian, including [employee and have signed] documentation of attendance. [at the orientation; and]

(b) A contractor must provide continuing education for a certified guardian to meet the continuing education requirements adopted by the Judicial Branch Certification Commission under Texas Government Code §152.204. [Ongoing training as required in subsection (a)(5) of this section must be documented and each participant must sign that the participant attended the training. At a minimum, training must include:]

(c) In addition to the orientation [and] training required [specified] in subsection [subsections] (a)(3) [and (b)] of this section, a contractor must provide training in the following areas to employees providing guardianship services or having direct contact with individuals [case managers in the following areas]:

(1) conditions, diagnoses, and care approaches related to the individuals [aging and disability, including mental illness, intellectual disability, related conditions, physical disabilities, and other diagnoses that affect the population being] served;

(2) legal matters [issues], including:

(A) civil commitment of persons with an intellectual disability or a [and] mental illness;[,]

(B) testifying in court; [courtroom testimony,]

(C) protocols [protocol, etiquette] in the courtroom and other venues;[,] and

(D) local court policies and procedures; and

(3) financial [estate] management, including:

(A) providing money management services; [alternatives, record keeping,]

(B) keeping records of the money management services the contractor provides to the individual; and

(C) completing financial reports the contractor is required to submit to government agencies [completion of documents that will be filed with the court].

§361.61. Qualifications and Training Requirements for Volunteers of Contractors.

(a) A contractor that uses a volunteer who is not a certified guardian must ensure [that] the volunteer does not perform guardianship duties. A contractor's[, but the] volunteer may provide services that an HHSC [a DADS] volunteer may provide under Texas Human Resources Code §161.114(c).

(b) A contractor that uses a volunteer must:

(1) provide training that is relevant to the services a volunteer may provide [the volunteer will provide];

(2) assign an employee who is a certified guardian to supervise [to] the volunteer [a supervisor who is a certified guardian and an employee of the contractor];

(3) ensure that the volunteer does not provide services to an individual under the contract [a DADS ward] until documentation and observation indicate the volunteer is qualified to work with the individual [ward];

(4) ensure that the volunteer's supervisor:

(A) reviews all work completed by the volunteer;

(B) countersigns [(5) ensure that the volunteer's supervisor countersigns] all documentation the volunteer completes [completed by the volunteer]; and

(C) meets [(6) ensure that the volunteer's supervisor meets] with the volunteer at least one time a [once per] month and documents the meeting;

(5) [(7)] ensure [that] the volunteer protects the health and safety of the individual [ward];

(6) [(8)] provide additional training to the volunteer on skills needed to provide services at least annually; and

(7) [(9)] document training provided to the volunteer.

§361.67. [Criminal] Background Checks.

(a) A contractor must ensure that each employee or [and] volunteer of the contractor who has contact with an individual or has access to the individual's assets and benefits: [a DADS ward or the estate or benefits of a ward:]

(e) [(c)] If a contractor [an] employee or volunteer successfully fulfills [has successfully fulfilled] all requirements and conditions imposed by the court for an offense described in subsection (c)(2) [(b)(2)] of this section, and if there are extenuating circumstances that justify the individual's employment or volunteering with the contractor, the contractor may make a written request to the director of the GSP [the DADS Guardianship Services Program] for a waiver of an offense described in subsection (c)(2) [(b)(2)] of this section. The director of the GSP does [will] not waive the requirement for any offense described in subsection (c)(1) [(b)(1)] of this section. If the Judicial Branch Certification Commission does not approve certification or revokes current certification of an employee or volunteer as a guardian based on a criminal history, the contractor may not assign the employee or volunteer [individual] to work in any capacity with an individual [a DADS ward].

§361.69. Quality Assurance Plan.

(a) A contractor must develop a quality assurance plan that describes the contractor's system of self-monitoring to ensure:

(1) consistency and quality of care provided to an individual [wards of the guardianship program]; and

(2) compliance with:

(A) the Texas Estates Code;

(C) [(B)] other requirements imposed by the courts; [and]

(D) [(C)] the Guardianship Provider Handbook; [guardianship provider handbook, other]

(E) the contractor's own program policies and procedures; and[, rules, and standards.]

(b) A contractor must provide [make] a copy of the contractor's [its] quality assurance plan [available] to the GSP when requested [DADS contract monitoring staff at the request of DADS staff] and before an annual contract monitoring review.

(c) A contractor must review its quality assurance plan annually and update the plan [it] as necessary. If updated, the [The] contractor must provide a copy of the [an updated] plan to the GSP [DADS] contract manager [if the plan is updated].

§361.71. Fiscal Management.

(a) A contractor must establish policies and procedures that describe:

(1) an accounting system to ensure HHSC pays [that payment is made by DADS to] the contractor only for [if] services provided to an individual [have been rendered];

(2) a financial management system for an individual's finances, including monitoring money spent by a representative payee and tracking [system that includes] receipts and a description of the goods or services provided to an individual [for all fiscal matters for wards served by the guardianship program];

(3) a system to refund monies to HHSC [DADS] or to an individual [a ward] if needed;

(4) the contractor's compliance with state and federal laws and regulations regarding sound accounting practices [for the contractor]; and

(5) internal and external audits to be performed on a regular basis.

(b) A contractor must accept payment from HHSC [DADS] as full payment [in full] for services provided [rendered]. The contractor must not bill twice or receive additional funds for the same or other service provided to an individual [duplicate billing or receipt of other funds].

(c) A contractor must not seek or accept reimbursement from an individual for [a DADS ward to whom it provides] purchased services.

(d) A contractor must not collect:

(1) payment from an individual [a ward];

(2) a percentage of the Social Security or Supplemental Security Income check authorized under 42 U.S.C. §405(j)(4) [specified in the Omnibus Reconciliation Act of 1990]; or

(3) payment authorized by the court under [in accordance with] Texas Estates Code[,] §1155.002, [and] §1155.003, and §1155.202 while serving under an HHSC guardianship contract.

(e) A contractor must not use HHSC [DADS] funds [or DADS reimbursed staff time] to provide guardianship or other services to a person [an individual] who is not referred by the GSP or served under the contract [has not been referred by DADS].

(f) A contractor must provide all legal support to an individual necessary for the guardianship services contracted by HHSC [DADS], including contested applications for guardianship.

(g) A contractor must provide the GSP [DADS staff] access to the results of audits performed by other government agencies on an individual's financial accounts [DADS wards].

§361.73. Roles and Responsibilities of a Contractor Providing Guardianship Services [Case Managers].

(a) After a contractor receives [Upon receipt of] a referral from HHSC [DADS], the contractor [a case manager] monitors the filing of legal documents, [accountings,] reports, notifications, and taxes as required by state law.

(b) A contractor [case manager] performs [the following] duties in accordance with the court [other duties and responsibilities outlined in the] order granting guardianship, the Judicial Branch Certification Commission Code of Ethics and Minimum Standards, other responsibility as Guardian of the Person under the Texas Estates Code. A contractor also performs the following duties:

(1) [(2)] ensures that an individual [a ward] has access to adequate care, protection, and services based upon identified needs and the service plan;

(2) [(7)] resolves issues or problems that affect an individual [a ward];

(3) [(8)] to the extent [as much as] possible, determines an individual's [considers a ward's] wishes and preferences before making decisions on the individual's behalf [choices when decisions are being made about the ward];

(4) [(9)] maintains documentation of face-to-face visits;

(5) [(10)] informs the GSP [the appropriate DADS and contractor staff] concerning major issues involving an individual [a ward] and documents all actions in the case [ward's] record; and

(6) [(11)] ensures documentation is complete and up-to-date:

(A) for [that] cases that are closed due to:

(iii) successor guardianship appointment; or [transferred, or]

(B) if the guardianship is transferred to another county [case manager, has documentation that is complete and up-to-date].

§361.75. Reporting of Abuse, Neglect, or Exploitation.

(a) A contractor must report an allegation of abuse, neglect, or exploitation of an individual to the appropriate investigating authority [a ward to DFPS] within 24 hours after [of] discovery of the alleged abuse, neglect, or exploitation. The contractor must include in the report the specific suspected abuse, neglect, or exploitation of the individual that allegedly occurred.

(b) [(c)] A contractor must report an allegation of abuse, neglect, or exploitation of an individual to the GSP [of a ward to the DADS guardianship supervisor in the contractor's designated DADS region] within 24 hours or by the next working day after discovery of the alleged abuse, neglect, or exploitation, whichever is later. The contractor must include in the notification to the GSP [notify the DADS guardianship supervisor of] the specific suspected abuse, neglect, or exploitation that allegedly occurred when the contractor [it is] reported the allegation of abuse, neglect, or exploitation to the investigating authority, and the actions the contractor has[. The contractor must also report what actions have been] taken to ensure the health and safety of the individual [ward].

(c) [(d)] If the alleged perpetrator is a contractor's employee, the contractor must remove the employee from working with the individual [any DADS wards] until all allegations have been investigated and a determination is made. If an allegation of abuse, neglect, or exploitation is validated [found to be valid], the contractor must take appropriate action. If the perpetrator has the right to appeal and if the appeal process determines the employee was not the perpetrator, the contractor [agency] must document the findings. If the allegation against the employee was unsubstantiated or found invalid, the contractor must retrain the employee before returning to work with an individual. [and reorient the employee before working again with DADS wards.]

§361.79. Responsibilities of the Guardian of the Person.

(a) A contractor, not [rather than] the contractor's employee or volunteer, is appointed by the court as guardian. A contractor must assign a primary case manager who meets the requirements described in §361.59(a)(2) of this subchapter (relating to Qualifications and Training Requirements for Contractor Employees) [§10.311(a)(2)] of this subchapter, to each individual [ward] served under its contract. The [with DADS. To ensure the ability to respond in a timely fashion in the event of an emergency, a] contractor must assign a back-up case manager who meets the requirements described in §361.59(a)(2) of this subchapter [staff] for when the primary case manager is unavailable.

(b) When [If] a contractor is appointed guardian of the person, the contractor must manage the individual's case [ward's person] according to:

(1) the court order appointing the contractor as guardian; and

(2) the Texas Estates Code requirements for Guardian of the Person. [guardian of the person. This responsibility may include:]

(c) A contractor arranges care and services for the individual [ward] based on [the] identified needs [of the ward] to enhance the individual's [ward's] quality of life. The contractor ensures that the individual [ward] has access to basic care and services, including:

(1) a safe, clean environment;

(2) assistance in performing basic life functions;

(3) regular, nutritious meals;

(4) any needed medical, psychiatric, habilitative, or other services; and

(5) adequate supervision.

(e) [(d)] The contractor must have an in-person visit [a face-to-face contact] at least once a month with each individual [ward] served under [through] the contract [with DADS]. To the extent possible, the primary case manager makes the monthly visit [contacts]. If the primary case manager is unable to make a monthly visit, another certified guardian must complete the visit [contact, the contact must be made by another certified guardian]. If the individual's [ward's place of] residence prevents an in-person visit, for example, incarceration in a correctional facility, [face-to-face contact (for example, incarceration in a correctional facility),] the contractor may substitute [a] phone or virtual contact with the individual. If [ward or, if] phone or virtual contact is not possible with the individual [ward], contact with a person knowledgeable of the individual's [ward's] current condition may be substituted, for example, a correctional officer, an attorney, a judge, a probation or parole officer, or a medical doctor [(for example a jailer, an attorney, a judge, a probation or parole officer, or a medical doctor)]. The case manager or other certified guardian must document the monthly visit in the individual's [ contacts in the ward's] file within 10 working days after the visit.

§361.83. Service Plans for Individuals [Wards].

(a) A contractor must develop and update at least annually a service plan for an individual [each ward for which it is appointed as guardian of the person]. The service plan establishes a structured and systematic approach for delivery of supports and services to an individual [a ward] that maximizes the individual's quality of care, quality of life, and overall functioning [of the ward].

(b) A contractor must develop the initial service plan within three months after qualification as guardian [after taking and filing the oath of guardianship] and must update the service plan within 60 days after the anniversary of the qualification date [annually by the due date of the annual report required by the court].

(c) A contractor may develop its own format for the service plan or may use a format provided by the GSP [DADS]. The service plan must adhere to the Judicial Branch Certification Commission Minimum Standards for Guardianship. A service plan must be developed using the principles of person-directed planning and in a culturally competent manner, to meet the individual's preferences and needs. [include at least the following information:]

(d) [(e)] A contractor must ensure that services are provided by employees [persons] who can adequately communicate with the individual [ward]. The contractor may facilitate communication by using a translator or by other means if the contractor's employees do not speak the individual's [ward's] language. [A non-English speaking ward and the ward's family who attempt to communicate in English may require accommodation.] Whenever possible, the contractor must offer the individual [ward] the option of communicating in the individual's [the ward's] preferred language, even if the individual [ward] can communicate adequately in English.

(e) [(f)] Whenever possible the individual's [ward's] diet and clothing must reflect cultural preferences.

(f) [(g)] The service plan for the religious needs of the individual [ward] must reflect any expressed preferences [lifelong pattern] of religious affiliation. Funeral planning for the individual [for the ward] must reflect the cultural and religious values of the individual and the individual's [ward and the ward's] family whenever possible.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 9, 2026.

TRD-202603929

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 25, 2026

For further information, please call: (210) 267-7419

STATUTORY AUTHORITY

The repeal is authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Human Resources Code §161.073, which provides that the executive commissioner of HHSC may adopt rules for the administration of guardianship services.

The repeal affects Texas Government Code §524.0151 and Texas Human Resources Code §161.073.

§361.81. Responsibilities of Guardian of the Estate.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 9, 2026.

TRD-202603928

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 25, 2026

For further information, please call: (210) 267-7419

SUBCHAPTER D. CASE RECORDS MANAGEMENT

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Human Resources Code §161.073, which provides that the executive commissioner of HHSC may adopt rules for the administration of guardianship services.

The amendments affect Texas Government Code §524.0151 and Texas Human Resources Code §161.073.

§361.151. Confidentiality of Records.

(a) A contractor must not disclose information from the case record of an individual in any way that could identify the individual [on a ward served under the contract with the DADS Guardianship Services Program in a manner that identifies the ward] unless the disclosure of the information is necessary to perform [carry out] the duties [of the contractor, as] described in subsection (b) of this section. Texas Human Resources Code[,] §161.111 makes information about an HHSC [a DADS] guardianship case confidential, and this extends to the case record of an individual [DADS wards served through contracts with DADS]. All information in the case record of an individual is [records, reports, or working papers related to the case are] confidential and is [are] exempt from public disclosure under the Texas Open Records Act (Chapter 552, Government Code). [DFPS Adult Protective Services Division records are also confidential under Texas Human Resources Code, §48.101.]

(b) Examples of situations that might require disclosure of [pertinent] case record information about an individual [to be disclosed] include:

(1) arranging for the provision of services;

(2) facilitating involuntary mental health or intellectual disability commitment;

(3) cooperating with law enforcement during a [the] criminal investigation [of abuse, neglect, or exploitation]; and

(4) responding to a court order for disclosure.

(c) If a contractor shares information about an individual as described in subsection (b) of this section [a ward], the contractor must inform [advise] the recipient [of the information] that the information is:

(1) confidential; and

(2) must not be shared with anyone else [be further shared] without permission from the individual.

(d) HHSC [DADS] does not disclose to a contractor the name of a reporter who makes an allegation [a complaint] of abuse, neglect, or exploitation to DFPS. If a contractor learns the reporter's name or other identifying information, the contractor must not share this information with any other agency, except as described in subsection (f) of this section.

(e) [(f)] Except for the name of a reporter who makes an allegation of abuse, neglect, or exploitation to DFPS, upon [Upon] written request to a contractor, the contractor may provide a copy of [guardianship case] information from the case record of an individual [, except the name and other identifying information about a reporter, on a ward served under a DADS guardianship contract] to the following:

(1) the individual [ward] or the individual's [ward's] guardian;

(2) a court-appointed executor or administrator of a deceased individual's [ward's] estate;

(3) the individual's [ward's] private attorney;

(4) a guardian ad litem;

(5) [(6)] a court investigator or court visitor appointed by the court in a guardianship proceeding;

(6) [(7)] Disability Rights Texas, the federally mandated protection and advocacy system; and

(7) [(8)] out-of-state protective agencies.

(f) [(h)] Upon oral or written request, a contractor must release a copy of the entire case record of an individual, including the name of the reporter who makes an allegation of abuse, neglect, or exploitation to DFPS, and information from other agencies, to a law enforcement agency or prosecuting attorney for [requesting] a case under [current] criminal investigation, prosecution, or litigation against the contractor or HHSC [DADS]. A law enforcement agency must provide proof of identity before the contractor may release the requested information.

(g) [(i)] If a contractor releases information to an individual or entity as allowed under this section, the contractor must record the following information in the individual's [ward's] case record:

(1) the name of the requestor;

(2) the information that the contractor provided;

(3) the date the contractor provided the information; and

(4) a dated copy of the written or oral request [or date of the oral request].

(h) [(j)] Except for any DFPS case records and the name or other identifying information about a reporter who made an allegation of abuse, neglect, or exploitation to DFPS, when the GSP refers an individual [When the DADS Guardianship Services Program makes a referral] to a contractor, the GSP provides [DADS does not provide the entire case record unless] the contractor with the entire case record of the individual [is awarded guardianship and submits a written request for this information]. After the contractor is awarded guardianship, the GSP provides the contractor with the remaining personal identification [Upon referral to a contractor, DADS provides only the following] information as follows:

(1) oral case record information[, except the name and other identifying information about a reporter]; and

(2) written information, including: [the Client Assessment completed by the DADS guardianship specialist,]

(A) medical and psychological information;[,]

(B) names and addresses of relatives;[,]

(C) financial information and documents;[,]

(D) personal data, for example, Social Security number, Medicaid number, and date of birth; and [(for example, Social Security number, Medicaid number, and date of birth) pertaining to the proposed ward, and]

(E) a copy of the most recent photograph on file.

(i) [(k)] A contractor must comply with federally mandated requirements when an individual is living with acquired immunodeficiency syndrome (AIDS) or the human immunodeficiency virus (HIV) [restrictions concerning the sharing of the AIDS/HIV positive status of a ward or proposed ward with a proposed guardian].

(j) [(l)] If a contractor's case records include [files contain] confidential reports from other professionals [professional individuals] or agencies, for example, physicians, psychologists, law enforcement, HHSC Provider Investigations, or DFPS, [(for example, physicians, psychologists, law enforcement, the Department of Assistive and Rehabilitative Services, or DFPS),] the contractor must:

(1) not release this information; and

(2) refer the requester to the professional or agency. [to anyone other than the ward or the ward's guardian without first contacting the issuing professional individual or agency for consent to release the information. If the professional individual or agency does not agree in writing to the request, the contractor must not release the information. If the ward or the ward's guardian requests confidential reports from a professional individual or agency, a contractor may release the information, except a police report.]

(k) [(m)] A contractor may verbally [orally] share case information, except the individual's AIDS or HIV status [name and other identifying information about a reporter and the AIDS/HIV positive status of a ward or a proposed ward], with authorized personnel of a social services or medical agency working with the individual [ward or the proposed ward] to the extent this information is necessary for the social services or medical agency to provide services [to the ward or the proposed ward].

§361.153. Case Records of an Individual [Documentation Requirements].

(a) [(e)] A contractor [Data] must:

(1) ensure case records are [be] readily accessible;[,]

(2) provide read-only access [must be provided] to the GSP Oversight and Community Support Services Unit to the contractor's electronic database to review the records [the DADS contract manager] during monitoring [contract] reviews; and[, and there must be a means]

(3) be able to retrieve electronic case records [the data] in case of an electrical outage or equipment failure.

(b) [(f)] A contractor must not write or enter any time in advance [preprint or pre-enter any record of time] on a form used to document all required elements of the services delivered, as provided in the Guardianship Provider Handbook [program specific rules].

(c) [(g)] Case records [Records] must include:

(1) copies of all file stamped or certified legal documents related to the individual's guardianship [ward, preferably file-stamped copies if documents are file-stamped by the court in the local area when submitted];

(2) financial documents, including receipts of disbursements, bank account statements, trust fund statements, and investment statements;

(3) documentation of all case actions, including legal matters, case management, financial, health and safety, monthly status updates, and interactions with the individual, which must be documented within 10 working days after the activity and include:[;]

(4) [(5)] significant incidents regarding progress, illness, and accidents [that may be used as part of the service plan for the ward]; and

(5) [(7) ward] status updates of allegations of [identifying] abuse, neglect, or exploitation reported [incidents referred] to the appropriate investigative authority; [and]

(6) [(8)] a photograph of the individual, which is taken [ward updated] within 90 calendar days after the contractor's [initial] qualification as guardian and updated every two years thereafter;[.]

§361.155. Maintenance of Records.

(b) [(a)] A contractor must maintain all records until the later of the following occurs:

(1) seven years elapse from the expiration or termination date of the records; or

(2) all litigation, claims, and audit findings involving the records are resolved.

(c) [(b)] Upon termination of a contract, the contractor must ensure [the following]:

(1) records are stored and are accessible;

(2) someone is responsible for adequately maintaining the records;

(3) the GSP [DADS] contract manager is notified in writing regarding the location of the records and who to [DADS may] contact to access the records; and

(4) if there is a change in the location of the records or the contact to access the records, the contractor provides the GSP [a change in the person assigned to provide access to the records, the DADS] contract manager with [is provided] the updated information in writing within 10 calendar days after the date of the change.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 9, 2026.

TRD-202603930

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 25, 2026

For further information, please call: (210) 267-7419

SUBCHAPTER E. CONTRACT MONITORING AND COMPLIANCE

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Human Resources Code §161.073, which provides that the executive commissioner of HHSC may adopt rules for the administration of guardianship services.

The amendments affect Texas Government Code §524.0151 and Texas Human Resources Code §161.073.

§361.201. Monitoring Reviews.

(a) When a contractor accepts funds, the contractor [it] also accepts the authority of federal and state governments, including HHSC [DADS] as an agency of a state government, to perform reviews and audits and to have access to records.

(b) The GSP [DADS] conducts monitoring reviews of a contractor's guardianship services to determine [if the contractor is in] compliance with the contract and the contractor's [program] rules and requirements. The GSP conducts a [A] monitoring review [is conducted] at the contractor's location [where the contractor is providing the services] unless the GSP [DADS] specifies a different location.

(c) At the end [conclusion] of the review, the GSP [DADS] determines [the level of] compliance for [on] each guardianship principle reviewed, as listed [. Guardianship principles are set forth] in the HHSC Guardianship Provider Handbook [DADS guardianship provider handbook]. If HHSC finds [DADS considers] the contractor substantially out of compliance with the contract and with [the program] rules and requirements, the contractor is subject to corrective action and may be subject to sanctions.

(d) During the monitoring review, the contractor must provide:

(1) read-only access to the contractor's electronic database [adequate working space] for reviewing the records; and

(2) all records requested [DADS requests] for review.

(e) During the monitoring review, the GSP [DADS] may:

(1) review a sample of case records of individuals [wards' records] to determine the contractor's compliance with contract requirements;

(2) interview individuals, contractor employees, and volunteers [wards and staff];

(3) observe individuals, contractor employees, and volunteers [wards and staff];

(4) interview contractor employees or volunteers who interact with individuals [with whom agency staff interact] on a regular basis[, such as individuals associated with the probate courts]; and

(5) conduct other activities as appropriate.

(f) The GSP [DADS] may conduct a follow-up monitoring review to determine if the contractor has corrected the findings identified during a previous [at a preceding] monitoring review. A follow-up monitoring review may:

(1) be a focused review using targeted samples; and

(2) focus only on those guardianship principles the GSP [that DADS] determined to be out of compliance at the most recent [immediately preceding] monitoring review.

(g) The GSP [DADS] may expand a monitoring review period or the review sample at any time.

§361.203. Complaint Investigations.

(a) The GSP [DADS] conducts a complaint investigation of a contractor's services if the GSP receives a complaint related to the contractor's policies [if DADS receives complaints that relate to program rules] or procedures, or the contractor's employees or volunteers.

(b) The GSP [DADS] may conduct a complaint investigation at any time without giving notice to the contractor.

(c) The GSP [DADS] does not disclose the name of the reporter [individual] who made the complaint unless:

(1) specifically ordered to by a court of law; or

(2) requested by law enforcement [to disclose to law enforcement].

(d) During the complaint investigation, the contractor must provide the GSP:

(1) adequate working space for reviewing the records; and

(2) all records the GSP [DADS] requests for the review.

(e) The GSP [DADS] may conduct a follow-up to the complaint investigation to determine if the contractor has corrected the findings identified during the complaint investigation. A follow-up complaint investigation may:

(1) be a focused review using targeted samples;

(2) focus only on those standards that the GSP [DADS] determined to be out of compliance at the most recent [immediately preceding] complaint investigation; and

(3) include:

(A) a review of a sample of the case records of individuals [wards' records] to determine if the allegations are valid and if the complaint affects more than the individual [ward] whom the complaint concerned;

(B) interviews with individuals, contractor employees, and volunteers [wards and staff];

(C) observation of individuals, contractor employees, and volunteers [wards and staff];

(D) consultation with others, as appropriate; and

(E) other activities, as appropriate.

(f) The GSP [DADS] may expand the review period or the review sample for a complaint investigation or follow-up complaint investigation at any time.

§361.205. Fiscal Monitoring.

(a) Fiscal monitoring is the review of documentation that supports the contractor's billings as it exists at the time the GSP conducts a fiscal monitoring [DADS staff arrive to conduct the] review. HHSC [DADS] may recoup payment if the service delivery documentation does not support the contractor's billing.

(b) The GSP [DADS] may conduct a fiscal monitoring review:

(1) in conjunction with a monitoring review described in §361.201 of this subchapter (relating to Monitoring Reviews);

(2) independently of a monitoring review described in §361.201 of this subchapter;

(3) when a contract is terminated; or

(4) as a result of conducting a complaint investigation.

(c) If the GSP [DADS] identifies fiscal errors, HHSC recoups payment related to the errors in the exact amount HHSC paid the contractor [DADS recovers the funds without extrapolation].

§361.207. Sanctions.

(a) HHSC [DADS] may impose a sanction if the GSP [DADS] determines that the contractor failed to follow the terms of the contract or the contractor failed to comply with the GSP's [program] rules, policies, and procedures. Examples of these failures include:

(1) jeopardizing an individual's [a ward's] health and safety;

(2) failing to comply with a quality assurance plan [of correction];

(3) failing to follow an agreed-upon audit resolution payment plan;

(4) failing to provide services according to the contract or program requirements; and [or]

(5) a validated report of abuse, neglect, or exploitation when the perpetrator is a contractor [an] owner, employee, or volunteer who has contact with an individual or the individual's financial benefits [a ward or with the estate or benefits of a ward].

(b) HHSC [DADS] may impose a sanction described in this subsection.

(1) Plan of correction. The GSP [DADS] may require a contractor to submit a plan of correction that includes the date the findings will be corrected.

(2) Protective action plan. HHSC [DADS] may require a contractor to take immediate action and put into place an abbreviated and immediate protective action plan if the GSP [DADS] identifies health or safety issues. The plan must address the contractor's actions to be taken to ensure the health and safety of the individual [ward].

(3) Recoupment. The GSP [DADS] may collect money the contractor owes as the result of overpayments or other billing irregularities or both.

(4) Referral [Ward referral] hold. The GSP [DADS] may stop referring new individuals [wards] to the contractor. The GSP releases the [ward] referral hold [is released] when the GSP [DADS] determines the contractor has resolved the reason for the hold.

(5) Contractor hold. The GSP [DADS] may withhold a contractor's payments. The GSP releases the contractor hold [is released] when the GSP [DADS] determines the contractor has resolved the reason for the hold.

(6) Involuntary contract termination. HHSC [DADS] may terminate a contractor's contract for cause by citing the contractor's failure to follow the contract terms or comply with GSP [the terms of the contract or with DADS program] rules, policies, and procedures. When HHSC terminates a contract, HHSC [If DADS terminates a contract, DADS] conducts a financial review to determine any overpayment or underpayment [and makes a final review to determine if the contractor has met the terms of the contract]. If the account is overpaid, the contractor must reimburse HHSC [DADS] within 30 calendar days after the contractor receives [receiving] written notice from HHSC [DADS]. If the account balance is not paid in full, HHSC [by that time, DADS] may charge interest on all unpaid debts starting on the 31st day after the date the contractor received the written notice from HHSC [DADS]. HHSC computes the interest [Interest is computed] on a simple interest basis under [in accordance with the] Texas Finance Code[,] Chapter 304, on the unpaid balance due. HHSC [DADS] may charge and collect interest on installment payments. If a contractor appeals the contract termination [an appeal is made], interest continues to accrue during any administrative appeal process extending beyond the 31st day after notice of a balance due. If any part of an appeal is found in the contractor's favor, HHSC dismisses the interest that accrued against the part of the appeal found in the contractor's favor [is dismissed].

(7) Suspension. HHSC [DADS] may temporarily suspend the contractor's right to conduct business with HHSC [DADS]. The causes for and conditions of suspension are described in subsection (a) of this section. A suspension is in effect until after an investigation, hearing, or trial is concluded and HHSC makes [DADS can make] a determination about the guardianship program's [agency's] future right to contract. HHSC [DADS] may hold the contractor liable for [impute] the conduct of an individual, corporation, partnership, or other association to the contractor.

(c) A contractor may appeal a sanction proposed or imposed by HHSC [an adverse action DADS takes] against the contractor's [its] contract. To appeal [an action], the contractor must request an administrative hearing [the appeal] in writing in accordance with 1 TAC §357.484 (relating to Request for a Hearing) [1 TAC Chapter 357, Subchapter I.]

§361.209. Administrative Review.

(a) A contractor may request an administrative review as described in subsection (b) of this section [of the review team's methodology] if the contractor suspects a formal compliance monitoring by the GSP OCR Unit may not have been conducted according to established GSP rules and procedures.

(b) A contractor's request for an administrative review must:

(1) be in writing;

(2) identify the GSP rules and procedures the contractor believes the GSP OCR Unit [DADS] failed to follow;

(3) state the basis for believing the review was not conducted according to established rules and procedures; and

(4) be received by the GSP [DADS] within 10 calendar days after the date the contractor receives [contractor's receipt of] the written review findings.

(c) The GSP [DADS] gives the contractor written notice of the result of the administrative review via certified mail.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 9, 2026.

TRD-202603931

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 25, 2026

For further information, please call: (210) 267-7419

CHAPTER 551. INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONS

SUBCHAPTER C. STANDARDS FOR LICENSURE

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes new §551.51, concerning Workplace Violence Prevention.

BACKGROUND AND PURPOSE

The purpose of the proposal is to implement Senate Bill 463, 89th Legislature, Regular Session, 2025, which amended Texas Health and Safety Code §331.001 to include intermediate care facilities for individuals with an intellectual disability (ICFs/IID) and state supported living centers to the definition of "facility" for purposes of establishing workplace violence prevention requirements. The proposed rule establishes standards to protect health care professionals and facility employees from violent behavior and threats of violent behavior within ICF/IID settings.

The proposal is necessary to ensure that facilities adopt, implement, and enforce workplace violence prevention policies and plans, including committee structures, annual reviews, reporting processes, and training obligations. These requirements strengthen safety for facility employees and health care professionals by increasing preparedness, response procedures, and protections against retaliation associated with reporting workplace violence.

SECTION-BY-SECTION SUMMARY

Proposed new §551.51(a) requires each facility to create or designate a workplace violence prevention committee responsible for developing a workplace violence prevention plan; outlines the requirements for committee membership; and allows multi-facility organizations to have a single committee to serve all facilities, if facility-specific plans are maintained.

Proposed new §551.51(b) requires each facility to adopt, implement, and enforce a written workplace violence prevention policy. The policy must require the facility to consider committee recommendations, encourage reporting, protect staff from retaliation, and ensure compliance with HHSC rule requirements.

Proposed new §551.51(c) requires each facility to adopt, implement, and enforce a written workplace violence prevention plan. The plan must be specific to the facility setting, define workplace violence, and address training, security measures, incident reporting, investigation processes, and employee input. The plan must be reviewed annually by the committee, and facilities must provide access to the plan while ensuring sensitive security information is redacted.

Proposed new §551.51(d) requires facilities to provide immediate services to health care professionals and facility employees after an incident of workplace violence, permit staff to contact law enforcement, and prohibit discrimination or retaliation against persons reporting workplace violence or advising others of their right to report.

FISCAL NOTE

Victoria Grady, Deputy Chief, Finance, has determined that for each year of the first five years that the rule will be in effect, enforcing or administering the rule does not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years the rule is in effect:

(1) the proposed rule will not create or eliminate a government program;

(2) implementation of the proposed rule will not affect the number of HHSC employee positions;

(3) implementation of the proposed rule will result in no assumed change in future legislative appropriations;

(4) the proposed rule will not affect fees paid to HHSC;

(5) the proposed rule will create a new regulation;

(6) the proposed rule will not expand, limit, or repeal existing regulation;

(7) the proposed rule will increase the number of individuals subject to the rule; and

(8) the proposed rule will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Victoria Grady has determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because any additional duties to establish workplace violence prevention requirements will be incorporated into existing facility committees already providing compliance oversight. No additional resources or appropriations are anticipated.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule is necessary to protect the health, safety, and welfare of residents; does not impose a cost on regulated persons; and is necessary to implement legislation that does not specifically state that §2001.0045 applies to the rule.

PUBLIC BENEFIT AND COSTS

David Kostroun, Chief Regulatory Services Officer, has determined that for each year of the first five years the rule is in effect, the public benefit will be improved safety for health care professionals, facility employees, and residents through required workplace violence prevention plans, policies, reporting processes, and protections against retaliation, resulting in a safer environment for the delivery and receipt of services.

Victoria Grady has also determined that for the first five years the rule is in effect, there are no anticipated economic costs for persons required to comply with the rule because facilities are already obligated to ensure safe working conditions, and the rule aligns with existing operational practices.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that the proposal does not restrict or limit an owner's right to property and therefore does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal, including information related to the cost, benefit, or effect of the proposed rule, as well as any applicable data, research, or analysis, may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 26R018" in the subject line.

STATUTORY AUTHORITY

The new section is authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system and Texas Health and Safety Code Chapter 331.

The new section affects Texas Government Code §524.0151 and Texas Health and Safety Code Chapter 331.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 9, 2026.

TRD-202603921

Karen Ray

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 25, 2026

For further information, please call: (512) 438-3161

CHAPTER 562. LICENSED CHEMICAL DEPENDENCY COUNSELORS

The executive commissioner of the Texas Health and Human Services Commission (HHSC) proposes an amendment to §562.24, concerning Standards for Private Practice.

BACKGROUND AND PURPOSE

The proposal is necessary to comply with Texas Occupations Code (TOC) §111.004(c) and (d). House Bill (HB) 1700, 89th Legislature, Regular Session, 2025, amended TOC §111.004 by adding subsection (c) and (d).

TOC §111.004(c) requires HHSC to adopt rules necessary to provide clear and concise standards for patient records and the retention of those records related to a patient's consent to treatment, data collection, and data sharing.

TOC §111.004(d) requires that any rules adopted under TOC §111.004(c) must address the specific consent documentation required for telehealth services and include provisions, based on the standard of care, for consent documentation in an audio-only format.

To implement TOC §111.004(c) and (d), the proposed amendment to §562.24 adds definitions and requirements for a Licensed Chemical Dependency Counselor (counselor) in private practice to provide counseling services as a telehealth service using electronic means.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §562.24(a) updates language to improve clarity and readability.

The proposed amendment to §562.24(b) adds new definitions to provide clarity for terms used in the subsection. The proposed amendment allows a counselor to provide counseling services using electronic means and outlines the requirements the counselor must follow, including providing in-person, face-to-face counseling services when requested.

The proposed amendment also requires the counselor to have access and security measures in place when communicating with the client electronically and outlines the criteria that must be met to use synchronous audiovisual technology and audio-only technology to provide outpatient counseling services. The proposed amendment outlines the counselor's responsibilities when technical problems occur and requires adequate security and encryption measures to protect client communications, recordings, and records that adhere to federal and state privacy laws.

The proposed amendment also requires the counselor to create safeguards to ensure adolescent clients receive counseling services separate from adult clients and to verify the identity of the client and any authorized representative.

The proposed amendment requires the counselor to provide appropriate referrals for clients that do not meet the criteria for services. The proposed amendment requires the counselor to provide the criteria for assessing appropriateness of providing services using electronic means and to document the client's verbal consent for participating in counseling services through electronic means. The proposed amendment outlines the counselor's responsibilities for obtaining verbal consent to provide counseling services using electronic means and if verbal consent is not obtained, requires in-person and face-to-face counseling services to be provided instead.

The proposed amendment requires the counselor to inform the client who consents to participating in counseling services using electronic means that the counselor will monitor services for evidence of fraud, waste, and abuse; determine if the client needs additional social services or supports; document the client's verbal consent to participate in the services using electronic means and adhere to federal privacy laws for providing services through electronic means.

The proposed amendment also requires the counselor to provide the client with emergency contact information; to maintain information for client continuity of counseling services based on the client's physical location; and provide accommodations for the client on request to support the client's effective participation in counseling services including through electronic means.

The proposed amendment also updates language to improve clarity and readability and updates outdated references.

FISCAL NOTE

Victoria Grady, Deputy Chief, Finance, has determined that for each year of the first five years that the rule will be in effect, enforcing or administering the rule does not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rule will be in effect:

(1) the proposed rule will not create or eliminate a government program;

(2) implementation of the proposed rule will not affect the number of HHSC employee positions;

(3) implementation of the proposed rule will result in no assumed change in future legislative appropriations;

(4) the proposed rule will not affect fees paid to HHSC;

(5) the proposed rule will create new regulations;

(6) the proposed rule will expand existing regulation;

(7) the proposed rule will not change the number of individuals subject to the rule; and

(8) the proposed rule will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Victoria Grady has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because there is no requirement to alter current business practices and the rules do not require the counselor to provide counseling services as a telehealth service.

LOCAL EMPLOYMENT IMPACT

The proposed rule will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to this rule because the rule is necessary to protect the health, safety, and welfare of the residents of Texas; does not impose a cost on regulated persons; and implements legislation that does not specifically state that §2001.0045 applies to the rule.

PUBLIC BENEFIT AND COSTS

David Kostroun, Chief Regulatory Services Officer, has determined that for each year of the first five years the rule is in effect, the public benefit will be improved standards for LCDCs providing telehealth services. The public will also benefit from increased clarity regarding requirements for telehealth services.

Victoria Grady has also determined that for the first five years the rule is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rule because the rule does not require the counselor to provide counseling services as a telehealth service.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that the proposal does not restrict or limit an owner's right to the owner's property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal, including information related to the cost, benefit, or effect of the proposed rule, as well as any applicable data, research, or analysis, may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 26R015" in the subject line.

STATUTORY AUTHORITY

The amendment is authorized by Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, TOC §504.051, which authorizes the executive commissioner to adopt rules governing the performance, conduct, and ethics for persons licensed as LCDCs, and TOC §111.004, which authorizes the executive commissioner to adopt rules for health professionals providing telehealth services.

The amendment implements Texas Government Code §524.0151, TOC §504.051, and TOC §111.004.

§562.24. Standards for Private Practice.

(a) This subsection applies to a Licensed Chemical Dependency Counselor (counselor) in a [counseling records of an LCDC's] private practice setting. A counselor providing services outside of a private practice setting shall follow the relevant regulations and standards for that setting, including those for documentation. [Documentation of professional services rendered in another setting shall be created and maintained in accordance with any legal requirements for documentation applicable to the particular setting in which they were provided.]

(1) When a counselor provides services in a private practice setting, the [The] counselor shall establish [and maintain] a record for every client on the date [at the time of] initial service delivery begins, maintain the record throughout the clinical relationship, and retain the record in accordance with paragraph (9) of this subsection. The client record shall include:

(A) client identifying information;

(B) assessment results, including a statement of the client's problems, [and/or] diagnosis, or both;

(C) plan of care;

(D) documentation of each counseling service [all services] provided, including date, duration, and if the service was delivered in-person, face-to-face; using synchronous audiovisual technology; or using synchronous audio-only technology [method of delivery]; and

(E) a description of the client's status at the end of each counseling service [time services are discontinued].

(2) The counselor shall maintain a record of all charges billed and all payments received.

(3) All entries in the client record shall be permanent, legible, accurate, and completed in a timely manner.

(4) All documents and entries in the client record shall be dated and authenticated. Electronic records shall be authenticated [Authentication of electronic records shall be] by a digital authentication key.

(5) When correcting [it is necessary to correct] a paper or an electronic client record, the counselor [error] shall mark [be marked] through the error with a single line, then date [dated], and initial the correction [initialed by the counselor].

(6) The counselor shall protect all client records and other client-identifying information from destruction, loss, tampering, and unauthorized access, use or disclosure. Electronic client information shall be protected to the same degree as paper records and in accordance with applicable law and accepted security standards for electronic health records prevailing at the time, and shall have a reliable backup system.

(7) The counselor shall comply with all applicable state and federal laws relating to confidentiality of client records, including:

(A) the requirements of Texas Health and Safety Code[,] Chapter 611, Mental Health Records [(relating to Mental Health Records)] and

(B) Code of Federal Regulations (CFR), Title 42, Part 2, Confidentiality of Substance Use Disorder Patient Records [(relating to Confidentiality of Alcohol and Drug Abuse Patient Records)].

(8) The counselor shall not deny clients access to the content of the clients' [their] records except as provided by law, including Texas Health and Safety Code[,] §611.0045, Right to Mental Health Record [(relating to Right to Mental Health Record)].

(9) The counselor shall keep client [Client] records [shall be kept] for at least five years after the date of final service delivery. The counselor shall keep records [Records] of adolescent clients [shall be kept] for at least five years after the client becomes 18 [eighteen] years of age.

(b) This subsection applies to a counselor [an LCDC] in private practice using electronic means [ the internet or telephone] to provide chemical dependency counseling services.

(9) [(1)] The counselor providing counseling services using electronic means must be licensed in Texas, meet an exemption as described in §562.2 of this chapter (related to License Required), or meet the requirements described in §562.33 of this chapter (related to Licensing, Certification, or Registration of Military Service Members, Military Spouses, and Military Veterans) [must reside in and perform the services from Texas].

(10) [(2)] The Texas Health and Human Services Commission (HHSC) [department] maintains its authority to regulate the counselor regardless of whether the client is at a different physical location than the counselor during a counseling service [the location of the client].

(13) [(3)] The counselor shall be aware of [is subject to] the applicable laws of other states and countries where the client may reside or receive services by electronic means, including any laws limiting the counselor's practice.

(15) [(4)] The counselor's provision of services by electronic means [medium] must comply with applicable law and accepted security standards, [standards at the time,] including, as applicable:[,]

(A) 42 CFR Part 2, Confidentiality of Alcohol and Drug Abuse Patient Records; [Code of Federal Regulations, Title 42, Part 2 (relating to Confidentiality of Alcohol and Drug Abuse Patient Records),]

(B) Texas Health and Safety Code[,] Chapter 611, Mental Health Records; [(relating to Mental Health Records), and]

(C) HIPAA [the Health Insurance Portability and Accountability Act of 1996 (HIPAA)] (P.L. 104-191);[, and]

(D) the Health Information Technology for Economic and Clinical Health Act; and [(HITECH Act),]

(E) Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5 (Feb. 17, 2009), and [their] implementing regulations, including:

(i) 45 CFR Part 160, General Administrative Requirements; [45 Code of Federal Regulations Parts 160 (relating to General Administrative Requirements),]

(ii) 45 CFR Part 164, Security and Privacy; and [164 (relating to Security and Privacy), and]

(iii) 45 CFR Part 170, Health Information Technology Standards, Implementation Specifications, and Certification Criteria and Certification Programs for Health Information Technology. [170 (Health Information Technology Standards, Implementation Specifications, And Certification Criteria And Certification Programs For Health Information Technology).]

(16) [(5)] The counselor must be able to verify the identification of the client and ensure the client's appropriate age.

(18) [(6)] If the [a] counselor uses the Internet as the electronic means to transfer or send counseling, [by which counseling is provided or transfers] client, or other protected health information through the Internet, the counselor shall [must comply with the following]:

(A) only transfer counseling, client, and other protected health information [may only be transferred] using encryption that meets or exceeds the Security Standards for the Protection of Electronic Protected Health Information under 45 CFR [Code of Federal Regulations] Part 164, Subpart C[, that are in effect at the time];

(B) only use e-mail communication containing counseling, client, or [and/or] other protected health information using the security standards outlined [is subject to the restrictions set forth] in subparagraph (A) of this paragraph; and

(C) [the counselor must] provide [technical] backup for technical [system] problems by providing a phone number to the client to call for technical support and a contingency plan for the client when a technical problem occurs.

(20) [(8)] Before engaging clients in services through electronic means, the [The] counselor must provide a description of all services offered to the client in writing and describe who is appropriate for the services. The counselor [description] must also provide [include]:

(B) [(A)] a grievance procedure, developed by the counselor, which includes the website and phone number to HHSC for filing a complaint [and provide a link to department information for filing a complaint when using the Internet and the toll-free number for the department when counseling by telephone];

(C) [(B)] the counselor's credentials, education level, and training;

(D) [(C)] the website and phone number to HHSC for licensure verification [a link to the licensure verification page when using the Internet and the toll-free number for the department when counseling by telephone];

(E) [(D)] the difference between traditional [electronic] counseling services provided in-person and face-to-face and [traditional] counseling services provided using electronic means; and

(F) [(E)] the potential risks to clients, including the following areas: [risk regarding clinical issues, security and confidentiality.]

(25) [(10)] The counselor shall [must] provide an emergency contact person and phone number and emergency procedures to the client in writing.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on September 9, 2026.

TRD-202603932

Stephanie Tourk

Chief Counsel

Health and Human Services Commission

Earliest possible date of adoption: October 25, 2026

For further information, please call: (512) 834-4591